Risky Business: The Stigma of PrEP and the Consequences for HIV Prevention

Risky Business: The Stigma of PrEP and the Consequences for HIV Prevention

Since PrEP — pre-exposure prophylaxis — was approved as an HIV prevention method in 2012, stigmas surrounding it have affected its adoption. PrEP involves taking a specific HIV medication — the current brand is Truvada — daily in order to significantly lower the risk of getting HIV. Those taking the drug are often stigmatized as promiscuous and willing to engage in risky sexual behavior. The media has even portrayed it as a “party drug” and users have been labeled as “Truvada whores.”

In a new study, published in Sociology of Health & Illness, Graduate Center doctoral student Mark Pawson (Sociology), along with CUNY Graduate School of Public Health & Public Policy Professor Christian Grov(Ph.D. ’07, Sociology), took a deeper look at the stereotypes attributed to PrEP users and how these attitudes affect use of the drug.

Pawson and Grov reviewed a series of focus groups of gay and bisexual men in New York City. They found that men who had negative opinions of the drug viewed PrEP users as promiscuous and irresponsible and that PrEP was encouraging men not to use condoms. Pawson explains that HIV prevention has traditionally focused on the message, “use a condom every time.”

“PrEP, for a certain generation, challenges the messaging that the one and only acceptable form of practicing HIV prevention is using condoms and anything outside of that is seen as immoral,” says Pawson. Yet PrEP is a safe alternative method of HIV prevention and is recommended for men who are having high-risk sex with men.

The participants believed that PrEP users were more likely to have unprotected sex and because of this felt that PrEP was responsible for the spread of other sexually transmitted diseases in the gay and bisexual communities. Some even viewed PrEP users as higher-risk partners because they viewed them as more likely to have multiple partners and spread disease.

Men were also being judged based on the reasons they were using PrEP. If someone was in a monogamous relationship with a partner who had HIV, that was an acceptable reason to use PrEP, whereas if someone was using the drug so they could have casual sex without condoms, that was deemed immoral.

According to the authors, these perceived and experienced stigmas surrounding PrEP are significant barriers to its use.

“There are other prevention methods besides condoms,” says Pawson.
“There is a lot of nuance in how to practice safe sex and some of the older prevention messaging is creating conflict with some of these newer prevention strategies.” Pawson believes that creating more inclusive messaging that describes the various options and their effectiveness would help dispel some of these attitudes and could be even more effective at reducing HIV.